How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Facility Modifier None Typical Low $112.20 Median $269.15 Typical High $7,413.10 | Facility | None | $112.20 | $269.15 | $7,413.10 |
Aetna Setting Professional Modifier None Typical Low $112.20 Median $263.03 Typical High $354.81 | Professional | None | $112.20 | $263.03 | $354.81 |
BCBS North Carolina Setting Facility Modifier None Typical Low $107.15 Median $158.49 Typical High $218.78 | Facility | None | $107.15 | $158.49 | $218.78 |
BCBS North Carolina Setting Professional Modifier None Typical Low $114.82 Median $229.09 Typical High $645.65 | Professional | None | $114.82 | $229.09 | $645.65 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $257.04 Typical High $416.87 | Facility | None | $56.23 | $257.04 | $416.87 |
Cigna Setting Professional Modifier None Typical Low $91.20 Median $223.87 Typical High $389.05 | Professional | None | $91.20 | $223.87 | $389.05 |
Medcost Setting Facility Modifier None Typical Low $95.50 Median $138.04 Typical High $389.05 | Facility | None | $95.50 | $138.04 | $389.05 |
Medcost Setting Professional Modifier None Typical Low $112.20 Median $302.00 Typical High $524.81 | Professional | None | $112.20 | $302.00 | $524.81 |
United Setting Facility Modifier None Typical Low $77.62 Median $165.96 Typical High $1,096.48 | Facility | None | $77.62 | $165.96 | $1,096.48 |
United Setting Professional Modifier None Typical Low $109.65 Median $213.80 Typical High $354.81 | Professional | None | $109.65 | $213.80 | $354.81 |
10 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $56.23 Median $109.65 Typical High $131.83 | Professional | 52 · Reduced service | $56.23 | $109.65 | $131.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.39 Median $43.65 Typical High $53.70 | Professional | 53 · Discontinued | $22.39 | $43.65 | $53.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $85.11 Median $162.18 Typical High $199.53 | Professional | 54 · Surgery only | $85.11 | $162.18 | $199.53 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.98 Median $32.36 Typical High $39.81 | Professional | 55 · Aftercare only | $16.98 | $32.36 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.22 Median $21.88 Typical High $26.92 | Professional | 56 · Pre-op care only | $11.22 | $21.88 | $26.92 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $79.43 Median $151.36 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $79.43 | $151.36 | $186.21 |
Medcost Setting Facility Modifier 50 · Both sides Typical Low $134.90 Median $208.93 Typical High $588.84 | Facility | 50 · Both sides | $134.90 | $208.93 | $588.84 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $44.67 Median $69.18 Typical High $194.98 | Facility | 51 · Multiple procedures | $44.67 | $69.18 | $194.98 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $169.82 Median $549.54 Typical High $776.25 | Professional | 50 · Both sides | $169.82 | $549.54 | $776.25 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $56.23 Median $181.97 Typical High $257.04 | Professional | 51 · Multiple procedures | $56.23 | $181.97 | $257.04 |
Where North Carolina sits
The same service costs 4.6 times more in Wisconsin than in Kentucky. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
North Carolina· 30th of 51
$229
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.